CMS Formulary

Displaying 128251-128260 of 1611142 results.
ID: 128251
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308979
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128252
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197303
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128253
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197304
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128254
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197853
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128255
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858813
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128256
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858817
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128257
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858810
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 128258
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 308973
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 128259
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858824
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 128260
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 858828
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30